Abstract
Purpose
To determine the prevalence and natural history of nmCRPC prior to the adoption of
novel androgen receptor axis-targeting therapies(ARAT).
Materials and Methods
This was a retrospective population-based cohort study of men with nmCRPC in Ontario,
Canada between January 2007-March 2018. Patients with prostate cancer, castrate level
of testosterone(<1.7nmol/L) and a PSA>2.0ng/mL with a subsequent rise>25% from the
nadir, and without metastasis were included. Annual prevalence of nmCRPC was calculated.
Crude time from nmCRPC to metastasis and all-cause death are presented as medians
with interquartile range(IQR). Predictors of time from nmCRPC to death were compared
using univariable and multivariable cox proportional hazard models.
Results
We identified 2045 patients with nmCRPC. Median age was 79(IQR:72-84). 984 patients(48.1%)
received upfront hormonal therapy while 583(28.5%) received initial radiotherapy and
478(23.4%) underwent radical prostatectomy. Median time from primary treatment to
nmCRPC was 6 years(IQR:3-10). The average annual prevalence of nmCRPC was 8% among
men receiving ADT. Crude median time from nmCRPC to death was 37.6 months(IQR:22.1-55.4).
Median time from nmCRPC to metastasis and metastasis to death was 20.0 and 8.3 months,
respectively. Patients who had primary surgery experienced longer crude survival.
Older patients, patients who had a higher PSA at nmCRPC, and patients with grade group
4 to 5 disease had a shorter time from nmCRPC to death.
Conclusion
This is the largest population-level analysis of the prevalence and natural history
of nmCRPC. The current study can be used as a historical cohort to compare how novel
imaging modalities and ARAT impact prevalence and disease trajectory over time.
Keywords
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Article Info
Publication History
Published online: October 12, 2022
Accepted:
October 4,
2022
Received in revised form:
October 3,
2022
Received:
June 10,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
